By Mike Safley
Marilyn Nishitani casts her gaze on the little girl from Musqa Runa. Maribie’s brown eyes take in Marilyn’s crystal blue iris’s, the white skin and spiky gray hair. At 12 years of age, an orphan for most of those years, the little girl has never even talked with a gringo woman, let alone been poked and prodded with gentle concern. As Marilyn knelt on one knee to take her pulse she patiently asked questions in English which were translated to Spanish answered and re-translated to English. Like a detective trying to solve the medical crime of disease, she finished her exam, issued a prescription and spent a few moments talking softly with Maribie. The scene was repeated 95 times on that November Saturday in Macusani.
Ms. Nishitani is no ordinary nurse. As a Nurse Practitioner she is licensed to diagnose cases and prescribe medicine just like a doctor. In fact she has a Doctorate of Nursing degree, which is unusual for her profession. Full of energy, Marilyn was upset when we closed the clinic Saturday evening, “I wanted to see at least 100 patients today,” she said, “why close up now?” There were lots of reasons: 8 straight days of patients, the late hours, the need to tear down and pack for an early morning departure, but Marilyn’s energy had not dimmed, her compassion had not diminished with each new patient.
When Laliang Aguilar Taipe sat down she said, “I have pain in my heart.” Out comes Marilyn’s stethoscope. The heart sounded loud, the pulse was strong. “When does it hurt?” “All the time,” she said and a doctor told her she had heart disease. The small brown Quechua lady seemed resigned at 43 years of age to believe that her condition was hopeless.
“How many children do you have?” asks Marilyn. “7,” she says, “but 2 died”. “How did they die?” asks Marilyn very softly. “Well 2 years ago my 19-year-old boy got sick. Five days later he died,” the mother whispers. “They told be he has leukemia.” A question about the other reveals that 5 months ago a daughter died after three days of illness. Again the daughter was diagnosed with leukemia. Next, another child was sick, he didn’t die but a doctor said he had leukemia as well. By now Marilyn was in tears.
Marilyn drew a deep breath and told the woman that it was a statistical improbability that her children each had leukemia, she explained that they would not have gone so quickly and that Laliang, who feared that she had given her children leukemia at birth, was not the cause of their illness. Children do not inherit leukemia. Marilyn suspected the children had high white cell count at death but that leukemia was simply a false diagnosis.
Marilyn’s diagnosis of Laliang: Depression: Depression Anxiety. She prescribed 3 months of anti-depressants. A mother of five children, Marilyn relayed her diagnosis to Dr. Bailey. Together they decided to make the prescription for 6 months. Even more than the pills, Marilyn’s kind words absolving the mother from responsibility for her children’s death were sure to provide immediate relief.